Adolescent Substance Abuse Treatment Research Articles

Advances in adolescent substance abuse treatment.

Alcohol and other drug use among adolescents has been a public health problem for decades. Although some substance use may be developmentally routine, a concerning number of adolescents meet criteria for a substance use disorder and could greatly benefit from a quality treatment experience. However, parents and health care providers want evidence of the efficacy of adolescent-specific treatment programs. This review summarizes four factors surrounding the efficacy of current adolescent treatment programs: 1) adolescent-specific treatment services; 2) the variety of therapeutic modalities; 3) relapse and recovery rates; and 4) the need for evidence-based, quality assessments and research. Current adolescent treatment efforts are summarized, and the recent literature regarding the efficacy of adolescent treatment and recovery rates is discussed.

Exploring the implementation of justice-based alcohol and drug intervention strategies with juvenile offenders: Reclaiming Futures, enhanced adolescent substance abuse treatment, and juvenile drug courts

There is a need for practice models to match young people in the juvenile justice system with timely and effective alcohol and drug intervention services. This paper reports on a new demonstration effort in which three practice approaches currently operating in the United States are being combined to maximize the potential of each. This public–private partnership combines juvenile drug courts (funded by the Office of Juvenile Justice and Delinquency Prevention), adolescent treatment improvement efforts (funded by the Center for Substance Abuse Treatment) and the Reclaiming Futures initiative (funded by the Robert Wood Johnson Foundation). Benefits of combining the three strategies are discussed, emergent implementation challenges and lessons are presented, and suggestions for further evolution are provided.

Family involvement in adolescent substance abuse treatment and recovery: What do we know? What lies ahead?

Families represent the most important resources that young people have in their journey through treatment toward recovery. Unfortunately, family members are often seen as part of the problem and not as part of the solution to adolescent alcohol and other drug (AOD) treatment and recovery. This attitude and misperception can be changed through education, outreach, and engagement of family members. Family involvement and creating a parent-professional collaborative partnership is a step toward improving the outcomes for adolescents in need of treatment and recovery. It is crucial that families understand the treatment process, as well as the hope, process, and reality of recovery. Without information families may not understand the importance of a treatment and recovery plan for their adolescent, the potential adverse consequences, and the impact of these AOD problems on other family members. Families need to learn the continuum of services and supports available, and how family participation improves treatment outcomes and strengthens the recovery process. Family involvement should be an essential part of intake, treatment, and recovery planning, as well as the foundation for effective parent–professional partnerships.

Toward an effective treatment system for adolescents with substance use disorders: The role of the states

A 2002 national expert panel found that the treatment system for adolescents with substance use disorders was inadequate and underdeveloped. The panel recommended immediate improvement in five areas: youth-serving agency collaboration, treatment system financing, workforce development, the implementation of evidence-based practices, and family involvement in all aspects of treatment. In 2004, the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA), designed the State Adolescent Substance Abuse Treatment Coordination Grant program (SAC) and implemented it in 2005 to address the critical need in the field. This paper reviews the adolescent substance use disorders treatment system, discusses selected drivers for change and the design of the SAC grant program, and summarizes some of the program's results. Both quantitative and qualitative data analysis document that substantive systems development occurred within each of the sixteen grantees and that federal–state partnerships are useful in creating systemic change.

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives.

Changes in neuropsychological functioning over 10 years following adolescent substance abuse treatment.

Previously, Anderson, Ramo, Cummins, and Brown (2010) described six distinct patterns of alcohol and other drug (AOD) use during the decade following adolescents' treatment for alcohol and other substance use disorders (A/SUD). This time period represents a phase of significant neurodevelopment, and the influence of substance use on the brain is a concern. In the present study, we examined patterns of neuropsychological function over these 10 years in relation to the AOD trajectories identified for youth as they transition into their twenties. Participants were part of a longitudinal research project following adolescents with and without A/SUD who received neuropsychological examinations at baseline and up to 7 times thereafter spanning 10 years (N = 213; 46% female at baseline). Neuropsychological trajectories were significantly related to substance involvement patterns over time on measures of verbal learning and memory (ps = .011 to <.0001), visuospatial memory (p = .0002), and verbal attention/working memory (p = .020), with heavier use patterns generally followed by poorer cognition. Heavy use of alcohol alone was independently associated with poorer verbal memory over time. Furthermore, substance withdrawal symptoms during each follow-up time point were related to poorer verbal learning and memory scores (ps < .05), whereas substance abuse/dependence diagnostic criteria were not related to neuropsychological performance levels. These findings suggest that AOD use during adolescence and young adulthood may primarily influence performance that relies on later maturing brain structures, although further research is needed. Higher levels of AOD withdrawal symptoms may signify greater neuropsychological impairment, reflecting potential neurotoxic effects of AOD use.

Child welfare agency ties to providers and schools and substance abuse treatment use by adolescents

Policy makers and advocates are increasingly encouraging child-serving organizations to work together. This study examined how child welfare agency ties with substance abuse treatment providers and schools correlated with substance abuse treatment for adolescents receiving child protective services. A sample of adolescents with substance use risk was extracted from a national survey of families engaged with child welfare. Logistic regressions with adjustments for complex survey design used child welfare agency ties to substance abuse treatment providers and schools to predict treatment. As expected, adolescents were more likely to report treatment when child protective services and substance abuse treatment were in the same agency and when child welfare agency directors reported joint planning with schools. However, child welfare agency agreements with substance abuse treatment providers were negatively associated with treatment. This unexpected finding implies that agencies may sometimes cooperate to address problems and to improve service utilization.

Perspectives on Adolescent Residential Substance Abuse Treatment: When Are Adolescents Done?

Perspectives on Adolescent Residential Substance Abuse Treatment: When Are Adolescents Done?

Perspectives on Adolescent Residential Substance Abuse Treatment: When Are Adolescents Done?

The study evaluated responses from adolescents in substance abuse treatment, their parents, and treatment staff to the question of what constitutes treatment success. Semistructured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at three residential substance abuse treatment programs in two states. Data were coded and organized into themes by respondent type. Respondents reported knowing when treatment was no longer needed based on changes in adolescents' substance use, treatment-related and other behaviors, and attitudes and character. A fourth category of responses indicated respondents' ambiguity regarding successful completion of substance abuse treatment. Little concurrence was found among adolescents, parents, and treatment center staff to indicate criteria suggesting that discharge is appropriate. Substance abuse treatment programs and their clients may benefit from ensuring that staff, parents, and adolescents are aware of treatment goals to promote more effective treatment and improve collaboration toward the adolescent's recovery.

P.6.e.005 Suicide and dual diagnosis

A retrospective record review of one year of admissions to a residential adolescent substance abuse treatment program (N = 91) examined the prevalence of comorbid psychiatric disorders and factors associated with successful treatment participation. Psychiatric and substance use disorders (SUD) were diagnosed by DSM-IV criteria. Successful participation was based on multiple factors assessed by the treatment team. Consistent with prior studies, there was considerable comorbidity (63.7%) with both disruptive (Attention Deficit Hyperactivity Disorder [ADHD], 11%; Conduct Disorder [CD], 24%) and other disorders (depression, 24%; adjustment disorder, 7.7%; bipolar disorder, 3.3%). Male gender was negatively associated (OR = 0.23, P = 0.019) with successful participation in univariate analyses, as was ADHD (OR = 0.18, P = 0.007). CD (OR = 0.37, P = 0.053) approached significance. Multivariate analysis reveals ADHD was significant while having CD and being male approached significance. Psychotropic medication use and other diagnoses were not associated with successful participation. It is concluded that further research on the relationship between ADHD, CD, and substance abuse treatment is needed.

Culturally relevant family‐based treatment for adolescent delinquency and substance abuse: understanding within‐session processes

Identifying psychotherapy processes that likely contribute to client outcome with ethnic minorities is a vital practice and research need, particularly within family-focused, evidence-based treatments (EBT) for youth with externalizing problems. Identifying process variables within a cross-cultural context may improve the efficacy of EBTs by informing psychotherapists how to modify their behavior when working with ethnically diverse clients. The authors described one approach to the development of culturally competent psychotherapy, using an observational coding system comprising Afrocentric codes to investigate culturally relevant therapist behaviors. Qualitative examples illustrated the quantitative findings relating to therapist in-session behavior that promote client engagement and positive responding during a midtreatment session of multisystemic therapy.

HIV Risk Behaviors: Risky Sexual Activities and Needle Use Among Adolescents in Substance Abuse Treatment

This study estimated prevalence of HIV risk behaviors and its association with substance use and mental health problems among adolescents in treatment. A pooled dataset of 9,519 adolescents admitted to substance abuse treatment programs between 2002 and 2006 was analyzed. HIV risk behaviors, substance use, and mental health problems were assessed at treatment intake. Sixty percent of adolescents were engaged in at least one sexual or needle use risk behavior in the year prior to entering treatment. Sex with multiple partners, sex under the influence of alcohol or drugs, and unprotected sex were the most prevalent HIV risk behaviors. Several gender differences were found for specific types of sexual and needle use behaviors. Adolescents with substance dependence or other comorbid mental health problems were at increased odds for HIV risk. Findings suggest treatment programs may benefit adolescents better by screening them consistently for HIV risk behaviors and incorporating tailored interventions.

Implementing Evidence-Based Multiple-Family Groups with Adolescent Substance Abusers

Agencies that provide adolescent drug treatment services have reported increased demand to treat multiple families in groups. However, little attention has been paid to the challenges associated with implementing multiple-family group interventions for adolescent substance abusers. To address this gap in the literature, the authors discuss the implementation of multiple-family groups embedded within a promising multimodal intervention called Strengths-Oriented Family Therapy (SOFT). We provide a brief description of the system of care within which the SOFT multiple-family groups were developed and outline the process of implementation. The authors discuss challenges they faced implementing multiple-family groups in their partnership with a not-for-profit agency using Gotham's (2006) conceptual framework for the transfer of evidence-based models into community practice. The challenges included meeting state licensure standards, providing services in rural areas, supervising the multiple-family groups, and addressing therapist's concerns and assumptions about the model. The authors conclude with practical recommendations for others that are developing or implementing multifamily groups as adolescent substance abuse treatment models.

Interventions for Reducing Adolescent Alcohol Abuse

To assess the effectiveness of substance abuse interventions for their ability to reduce adolescent alcohol use. MEDLINE; PsycINFO; ERIC; Wilson Social Science Abstracts; Criminal Justice Abstracts; Social Work Abstracts; Social Science Citation Index; Dissertations Abstracts International; National Criminal Justice Research Service; Social, Psychological, Criminological, Educational Trials Register; and the PsiTri databases from 1960 through 2008. Of 64 titles and abstracts identified, 16 studies and 26 outcomes constituted the sample. The researchers calculated Hedges g effect sizes and used a random-effects model to calculate adjusted pooled effect sizes. Heterogeneity was explored using stratified analyses. Main Exposure Completion of a substance abuse intervention that aimed to reduce or eliminate alcohol consumption. Abstinence, frequency of alcohol use, and quantity of alcohol use measured between 1 month and 1 year upon completion of treatment. Pooled effects of standardized mean differences indicate that interventions significantly reduce adolescent alcohol use (Hedges g = -0.61; 95% confidence interval [CI], -0.83 to -0.40). Stratified analyses revealed larger effects for individual treatment (Hedges g = -0.75; 95% CI, -1.05 to -0.40) compared with family-based treatments (Hedges g = -0.46; 95% CI, -0.66 to -0.26). Treatments for adolescent substance abuse appear to be effective in reducing alcohol use. Individual-only interventions had larger effect sizes than family-based interventions and effect sizes decreased as length of follow-up increased. Furthermore, behavior-oriented treatments demonstrated promise in attaining long-term effects.

Addiction Nursing and the Quality of Adolescent Substance Abuse Treatment

Addiction Nursing and the Quality of Adolescent Substance Abuse Treatment

Availability of HIV-related health services in adolescent substance abuse treatment programs

Given that alcohol and drug abuse heightens the risk of adolescents acquiring HIV, substance abuse treatment programs for youths may represent an important site of HIV prevention. In this research, we explored the adoption of three HIV-related health services: risk assessment during intake, HIV prevention programing, and HIV testing. Data were collection through telephone interviews with 149 managers of adolescent-only substance abuse treatment programs in the USA. About half of these programs had adopted HIV risk assessment and HIV prevention. On-site HIV testing was less widely adopted, with only one in four programs offering this service. At the bivariate level, the availability of on-site primary medical care and the availability of an overnight level of care were positively associated with these three types of services. The association for the measure of an overnight level of care was no longer significant once medical services were controlled. However, in a separate analysis, it was found that programs offering an overnight level of care were much more likely to offer on-site medical care than outpatient-only facilities. There was also evidence that publicly funded treatment programs were more likely to offer HIV prevention and on-site HIV testing, after controlling for other organizational characteristics. Much more research about the adoption of HIV-related services in adolescent substance abuse treatment is needed, particularly to offer greater insight into why certain types of organizations are more likely to adopt these health services.

An In-Depth Survey of the Screening and Assessment Practices of Highly Regarded Adolescent Substance Abuse Treatment Programs

Aims: To examine the quality of screening and assessment practices at some of the most highly regarded adolescent substance use treatment programs in the United States. Methods: Between March and September 2005, telephone surveys were administered to directors of highly regarded programs. Several different publications and databases were then used to measure the quality of the screening and assessment instruments described by programs. Results: For the 120 programs responding, 77 distinctly named instruments developed by outside sources were used at some point in the screening and assessment process, and the majority of programs also used instruments developed in-house. Fewer than half of these instruments were mentioned in the Substance Use Screening & Assessment Instruments Database. We were able to confirm that 87% of the instruments developed by others have a published manual, and 74% have been described in an article appearing in a peer-reviewed publication. Sixty-two percent were designed to be used with adolescents or adults and adolescents, while 19% were designed for adults only. Conclusion: Although adolescent substance abuse treatment programs recognized the importance of screening and assessment, the quality of such practices varied significantly. A large number of different tools were used by some of the most highly regarded programs in the country, and many used questionnaires developed in-house that may not have had high standards of reliability and validity. Furthermore, numerous programs were using assessment instruments that were not uniquely designed for adolescents. Encouraging the adoption of standardized assessment practices would help those involved in treatment to evaluate programs and to understand the assessment process.

Intentions to quit smoking among youth in substance abuse treatment

Introduction Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths’ intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment. Methods Participants were 178 adolescents who were in inpatient ( n = 90) or outpatient ( n = 88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD = 1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale). Results SUD youth intention to quit smoking averaged 4.9 out of 10 (SD = 3.2), comparable to intention to quit drinking (M = 5.3, SD = 3.6), but lower than their intention to quit using drugs (M = 6.0, SD = 3.4). Teens’ intentions to quit smoking were associated with nicotine dependence ( r = −.30, p < .01) and smoking cessation related self-efficacy ( r = .36, p < .01), but not with pretreatment substance use severity ( r = −.15). Controlling for nicotine dependence, teens’ intentions to quit smoking were positively related to smoking cessation self-efficacy ( pr = .26, p < .01) and intention to quit using illicit drugs ( pr = .15, p < .05), but unrelated to intention to quit drinking. Discussion Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research.

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.

Parental consent in adolescent substance abuse treatment outcome studies

No systematic review has focused on parental consenting procedures used in adolescent substance abuse treatment outcomes research. To address this gap, we examined parental consenting procedures in adolescent outcome studies ( n = 34) published between 1980 and 2007. Although parental consent was required in 89% of adolescent treatment outcome studies we reviewed, consenting procedures were not routinely reported. We argue that parental consenting procedures should be routinely reported as a methodological feature of adolescent treatment outcome studies and, given concerns about sample bias in adolescent risk behavior research when parental consent is required, encourage outcomes researchers in this area to prospectively study the impact of consenting procedures on both the study participation rates and substance use reporting.